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Organization

PRINCETON MEDICAL GROUP,P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SUSANA S GUMMEL (CFO)
(609) 924-9300
Entity
Organization

Contact information

Practice address
419 N HARRISON ST, SUITE 203, PRINCETON, NJ 08540-3521
(609) 924-9300
(609) 430-9481
Mailing address
419 N HARRISON ST, SUITE 203, PRINCETON, NJ 08540-3521
(609) 924-9300
(609) 430-9481

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
207R00000X
Internal Medicine Physician
Primary
207RC0000X
Cardiovascular Disease Physician
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
207RH0003X
Hematology & Oncology Physician
207RN0300X
Nephrology Physician
207RP1001X
Pulmonary Disease Physician
207RR0500X
Rheumatology Physician
207RX0202X
Medical Oncology Physician
207UN0901X
Nuclear Cardiology Physician
207V00000X
Obstetrics & Gynecology Physician
207VG0400X
Gynecology Physician
363A00000X
Physician Assistant
363LX0001X
Obstetrics & Gynecology Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0082556000
AMERIHEALTH/IBC SPEC GRP#
01
0082556004
AMERIHEALTH/IBC PCP GRP#
05
2979306
NJ
01
7149
AETNA GROUP NUMBER
Enumeration date
09/26/2006
Last updated
11/01/2024
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